Compression socks are not just for air travel anymore. Athletes use them to improve venous return for physical performance. People who stand for work report less fatigue with compression, even without recognizing edema. This entry is meant to help de-mystify compression hose. The first bit is that TEDS from the hospital don’t cut it. Throw them out if they go home with your patient.
Dosing:
Compression socks should come with 2 associated numbers: 8-15, 10-20, 20-30, 30-40, & 40-50 mm Hg. The high number represents the compression at the ankle and the low number is compression at the top of the calf, the idea being to create a gradient that moves edema proximally up the leg as the patient walks. The use of the calf muscles augments the effectiveness of the garments, so even if your patient doesn’t walk, wiggling the legs and feet will help the garment effect. The higher the number, the more the compression– and the harder the garment is to place. I usually start patients on 8-15 mm Hg compression, with the idea that early success may keep wearers willing to continue using the socks. A really high compression sock that my patient can’t place without breaking a nail, poking a hole through the sock, or tearing a rotator cuff is not going to be worn and not going to help control edema. A low level of compression my patient can manage without significant effort is more likely to be used. If it takes a squad of minions to place and remove, it’s going to stay in the drawer. Success with a garment that helps a little is better than failure with a garment that might have helped more if only it could have been placed and removed.
I have never met anyone who can tolerate thigh-high stockings. Thigh highs are an example of “better in theory than in implementation.” They bunch behind the knees and roll down the thighs. If your patient is willing in spirit to wear a thigh-high stocking, have him get compression yoga or running leggings at the sporting goods store instead. They are great for people with visible varicose veins but no edema yet.
Elastic wears out. Compression socks need to be replaced every 3 to 6 months, depending on how many pairs are in rotation. They can go through the washer (on gentle setting if possible) but should hang to dry, so your patient needs 3 pairs at a minimum: 1 on his legs, 1 in the drawer, 1 drying on the rack. Nobody’s 3-year-old compression socks are “compression” socks anymore, they are just socks.
Getting them on:
There are several donner devices that truly ease application. Mine was $27 on Amazon. Google “sock donner.” and watch the 10-second instruction video, because although use is simple, it is not intuitive. My favorite looks like a wire frame, and it comes in “average” and “wide calf” sizes. Compression in socks is additive: 2 layers of 8-15 socks provides about 15-30 mm Hg compression level and are much easier to apply and remove than a single layer of 15-30 mm Hg sock. Wearing a nylon knee high as a first layer can also make it easier to apply a compression sock layer, especially if it has to slip over a bandage.
Where to get them:
Some traditional prescription brands include Sigvaris, Juzo, Medi-, & Jobst. The advantage of these brands is that they tend to be more durable and are available in higher compression levels. The disadvantage is that they tend to be significantly more expensive than many of the brands that produce only lower compression level hose. Most of your patients really don’t need to spend $70 for a pair of compression socks. Dr. Motion, Dr. Comfort, Soxy, Footsmart, & Rejuva Health online, and chain stores like Marshalls, TJ Maxx, Kohls supply 8-15 and 10-20 mm Hg hose with fun colors and patterns in addition to sedate solids for both men and women.
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